Newsletter

When Doctors are the Problem: Stigmatizing Patients Suffering from Sexually Transmitted Diseases (STD)

With the alarming trends in a growing STD problem at all levels of our society it is important that an integrated, well-staffed and effective public health effort be deployed against this threat to our citizens. The STD clinic at the City of Lubbock Health Department is a mainstay of clinical services in our community. With the threat of reductions in funding from the state it is important that funding be maintained so that Lubbock’s current 187% of state averages in STD rates does not skyrocket even further.

A problem identified in news articles and clinical journals involves the attitudes and behavior of health care professionals who stigmatize those seeking STD services. Inaccurate statements combined with political rhetoric lacking in empathy work against the effort of public health to deal with this problem.

This lack of professionalism among doctors and others in health care regarding STDs is not new. Dr. Laura J. McGough, Ph.D., in an article on the American Medical Association web site (http://virtualmentor.ama-assn.org/2005/10/mhum1-0510.html)described the historical perspectives on this unfortunate attitude:

“In 1728, the impoverished Flora Price applied to her local parish churchwardens in London for assistance. Charitable support was provided at local parishes to carefully screened applicants. During her interview, she admitted that she suffered from the "pox," the common term for sexually transmitted diseases before physicians clinically distinguished between syphilis and gonorrhea. Instead of entering a hospital, she was sent to a workhouse, an institution created to correct "idleness," which at the time was widely regarded as the root cause of poverty. At the workhouse, she received mercury treatments for her illness. Her male contemporaries, however, were far more likely than indigent females to be admitted to hospitals, which provided bed rest in addition to mercury treatment. Female patients suffering from this "foul disease" did not win the sympathy of churchwardens as easily as male patients did. All poor patients, male and female, had to suffer the indignity of publicly admitting their diagnosis. Meanwhile, wealthy patients could afford private, confidential treatment with minimal, if any, loss to their reputations [1].

Historical cases about the "pox," such as the above example, provide useful insights about how stigma is perpetuated for present-day clinicians who treat acquired immune deficiency syndrome (AIDS) patients. The pox was regarded as a curable disease after the mid-16th century [2]. Stigma nonetheless persisted and was reinforced in a variety of ways. As the case of Flora Price shows, the health care and social services systems themselves can contribute to stigma by offering different levels of care with varying standards of privacy, confidentiality, and comfort to patients. Since the wealthy can more successfully shield their disease while the poor rely on public resources, the association between disease and poverty becomes more closely linked. It is, in fact, a vicious, self-reinforcing circle, since poverty can also make people more vulnerable to disease. Stigma is embedded in these wider social processes of power and domination, inequality, and poverty [3].”

Elizabeth Boskey, Ph.D. (http://std.about.com/b/2011/01/08/when-doctors-stigmatize-std-patients.htm ) noted that when STDs are so thoroughly stigmatized-particularly herpes, that this can “lead to feelings of hopelessness and worthlessness that are entirely out of proportion to the severity of the disease.” She goes on to offer that “although education about safe sex and risk reduction measures is an appropriate professional response to an individual who has recently been diagnosed with an STD, judgment and derision are not in the least because they may stop patients from coming in for help when they need it again.”

It is essential that such inappropriate behavior not be tolerated among those who provide care to our community. Allowing such mischaracterizations and insults to go unchecked is to only deepen the loss experienced by those afflicted. It is particularly troubling when a member of the local Board of Health harbors such views.

As a health-care professional we are directed by our ethics to provide care and, in the case of my physician colleagues, to “do no harm”. The person is not the disease they suffer from and they deserve to be treated with compassion and understanding.